Journal of Society of Surgeons of Nepal

Sick Surgeon: Problem and the panacea!

Bikal Ghimire — Fri, 31 May 2019 00:26:54 +0000

Gautam Buddha has rightly said ‘To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear’. We need clear minds as a clinician and more so as surgeon to plan the course of treatment and to physically execute it. However, apart from clear minds a surgeon should also be physically capable to withstand strenuous activities for long periods of time. Daily exertion for prolog periods for surgeons leads to poor quality of life especially in our subcontinent where health institutions and the government do not prioritize the health of clinicians.

The hematoma block for fracture reduction: double blinded randomized controlled trial

Suraj Bajracharya, Tamanna Bajracharya, Shriraj Shrestha — Fri, 31 May 2019 00:27:44 +0000

Prediction of Infectious Complications after Percutaneous Nephrolithotomy

Raj Kumar Chhetri, Suman Raj Baral — Fri, 31 May 2019 00:28:25 +0000

Introduction: Post-operative infection is one of the most common and potentially life-threatening complications following percutaneous nephrolithotomy, ranging from fever to severe sepsis. It is reported to be the most common peri-operative cause of death. Despite taking utmost precautions, we come across major complications such as haemorrhage and urosepsis after percutaneous nephrolithotomy. This study aims to find the risk factors for infectious complications after percutaneous nephrolithotomy.
Methods: This was an observational, cross-sectional, analytical study carried out in the Department of Surgery of Lumbini Medical College and Teaching Hospital over a period of six months. Pre-operative and intra-operative parameters of ninetyseven patients who underwent percutaneous nephrolithotomy were analysed to see the association between perioperative and intraoperative factors in development of post-operative infectious complications.
Results: Post-operatively, systemic inflammatory response syndrome was observed in 28.9% of the patients and 6.2% developed post operative sepsis. Stone burden, types of stone, abnormal urinalysis and mean operative time were associated with post-operative Systemic Inflammatory Response Syndrome while stone burden, abnormal urinalysis, positive urine culture and operation time were statistically associated with post-operative sepsis. In univariate analysis only mean operation time and mean stone burden were statistically associated in development of post operative SIRS and sepsis.
Conclusion: In the present study mean operation time and mean stone burden were found to be the predictive factors for post-operative infectious complications after percutaneous nephrolithotomy.
Key words: Operation time; Percutaneous nephrolithotomy; Systemic inflammatory response syndrome; Sepsis; Stone burden.

Clinical practice of minimally invasive gynaecological surgeries

binaya raj bhandari — Fri, 31 May 2019 00:29:04 +0000

Aims: This study was done to know the clinical practice of minimally invasive gynaecological surgeries in Minimally Invasive Diagnostic and Therapeutic (MIDAT) hospital.Methods: A hospital based descriptive study was conducted in gynaecological department of MIDAT hospital over 16 months period from 1st Bhadra 2071 to 30th Poush 2072 (17th August 2014 to 14th January 2016) among 115 women who underwent minimally invasive gynaecological surgeries (MIGS).Results: There were total 115 minimally invasive gynaecological surgeries done in MIDAT hospital during study period. Laparoscopic gynaecological surgeries and hysteroscopy were performed in 86 (75%) and in 29 (25%) women respectively. Among laparoscopy, laparoscopic hysterectomy {31 (36%)} was the more common operation. During laparoscopy, conversion to open was done in nine (10.5%) patients. Complications of MIGS were seen in three (3.5%) women.Conclusions: MIGS has got more technical difficulties but lesser morbidity, better patient’s satisfaction, smooth post operative recovery and shorter hospital stay compared to open gynaecological surgeries. In recent time, MIGS is gradually becoming popular in Nepal.Keywords: Hysteroscopy, Minimally invasive gynaecological surgery, laparoscopy

Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults

Rabindra K.C., Ishwor Lohani — Fri, 31 May 2019 00:29:50 +0000

Introduction: Appendectomy is the most commonly performed emergency operation in the world. The life time risk of undergoing appendectomy is around 8% and maximal incidence occurs in the second and third decade of life. Diagnosis of acute appendicitis (AA) is purely based on history, examination and few laboratory investigations. However, it is often a perplexing diagnostic problem during the early stages of the disease. Failure to make an early diagnosis is a primary reason for morbidity and mortality. Leukocytosis is being used commonly to diagnose acute appendicitis. Recently, it has been proposed that netrophil: lymphocyte count ratio (NLCR) is a more sensitive marker than leukocytosis in patients with acute appendicitis.Method: This is a prospective study conducted over a period of one year in the department of surgery, Tribhuvan University Teaching Hospital TUTH from September 2013 to August 2014.Total 106 patients were included in the study. AA was diagnosed by clinical and laboratory parameters. TLC and NLCR of patients diagnosed as AA was recorded in the proforma. Histological diagnosis was taken as the final diagnosis. SPSS software was used for analysis of data.Results: Male: Female ratio was 2.02:1, with mean age of 29.63 years .Right iliac fossa tenderness was the most common sign and an average leukocyte count of 12534/ul. All cases diagnosed clinically as acute appendicitis were confirmed histopathologically. NLCR> 3.5 was observed on 90.56% of patient whereas 78.3% of patients had leukocytosis which was statistically significant (p= 0.0001).Conclusion: NLCR is a more sensitive laboratory parameter than TLC in patients with acute appendicitis.

Outcome of Snodgrass Repair in Distal Hypospadias – An Institutional Experience

Deepak Thakur — Fri, 31 May 2019 00:30:32 +0000

Introduction: Hypospadias is a common congenital anomaly   in which   the urethral opening   is   on   the   ventral   surface   of   the   penis, often associated with ventral curvature of penis (chordee). Many techniques have been descried in the literature for the repair of hypospadias with variable results. This study aimed at outcome following Snodgrass repair in distal hypospadias by a single Urologist.

Methods:  This was a retrospective study conducted at Department of Urology, Birat Medical College from December 2017 to January 2019 during which 16 patients with distal hypospadias underwent primary repair using Snodgrass technique.
Results:    Mean age was 5.12 years and duration of operation was 136.25 minutes. About 56.25% of cases were subcoronal and 43.25% were coronal. Chordee of <30 degree was present in 25% of cases. Complications occurred in 25% cases of which half (12.5%) were urethrocutaneous fistula and rest were meatal stenosis (6.25%) and hematoma (6.25%).
Conclusion: The outcome of Snodgrass repair in distal hypospadias is satisfactory with acceptable complications and urethrocutaneous fistula is the commonest complication.

Treatment of advanced rectal cancers: Cylindrical abdominoperineal excision of rectum

Nirmal Lamichhane — Fri, 31 May 2019 00:31:14 +0000

Treatment for patients with locally advanced low lying rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Surgical resection will be the straightforward option for the early ones but multimodality treatment, including preoperative chemo-radiation and extended surgical resection will be the options for advanced ones. Cylindrical abdominoperineal excision of rectum (C-APER) along with possible composite pelvic organ resection is a surgical method to remove an adequate circumferential margin so to reduce the local recurrence rate and improve long term survival. Adequate preoperative imaging of the pelvis is therefore important to identify these patients and effort should be made to select those patients with advanced tumours with no systemic spread. In this article, we reviewed some consecutive cases of advanced rectal cancer to their immediate surgical outcome.

A case report Median arcuate ligament syndrome

Akash Chitrakar, Nirajan Subedi, Ramesh Singh Bhandari — Fri, 31 May 2019 00:31:58 +0000

Median arcuate ligament (MAL) syndrome results from extrinsic compression of the celiac axis and or celiac ganglion by the MAL and diaphragmatic crura. A seventy five years lady presented with post prandial epigastric pain for 6 months. She had undergone considerable investigations for other diagnoses before an abdominal computed tomography (CT) revealed median arcuate ligament impinging celiac artery at its origin. She successfully underwent laparotomy and release of median arcuate ligament.